Provider Demographics
NPI:1790020725
Name:DUKES, KRISTIE GAIL (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:GAIL
Last Name:DUKES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 THURMOND RD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-8255
Mailing Address - Country:US
Mailing Address - Phone:270-293-2042
Mailing Address - Fax:
Practice Address - Street 1:1081 THURMOND RD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-8255
Practice Address - Country:US
Practice Address - Phone:270-293-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant